DAYTON, Ohio (AP) — Health officials say a girl in southwest Ohio has been diagnosed with a case of diphtheria — an illness that has been extremely rare in the US since children started being vaccinated against it in the 1920s.

The Dayton Daily News ( ) reports that the adolescent girl was diagnosed after being hospitalized with symptoms similar to strep throat. The girl, who was released from the Dayton hospital earlier this month, may have been fully vaccinated.

The Ohio Department of Health said diphtheria is spread through close contact with discharges from an infected person’s nose, throat, eyes or skin lesions. Symptoms include fever, sore throat and fatigue. An infection in the skin could cause a rash.